IL-ACOFP Legislative Update

By Betsy D. Mitchell, MPA

IL-ACOFP Legislative Consultant

4th Quarter 2016

Overview

After a very long and very expensive campaign season nationwide, there were a few notable shifts in party affiliation regarding Illinois statehouse races. However, with the start of the next General Assembly set for January 11, 2017 questions still remain regarding how the election results may impact activity (or continued non-activity as has been the case for the past year) in Springfield, and more importantly, how will these results impact IL-ACOFP.

State Comptroller

In the statewide race for Comptroller, the Democratic challenger Susana Mendoza defeated the Republican incumbent Leslie Munger with slightly less than 50% of the vote. The two third party candidates received approximately 6% of the vote. The Comptroller’s office is the office that writes and sends the checks after each agency has given their approval.

It is important for IL-ACOFP to have a good working relationship with the Comptroller in Illinois. First, because it is the Comptroller’s responsibility to send the checks, it is important for the Illinois Comptroller to understand that Family Physicians are on the frontline when it comes to caring for most patients in need of medical care. Second, in the past the Comptroller has the power to provide a one-time emergency check to providers who can show immediate need.

On Friday, December 18, Congress passed S. 2425, the Patient Access and Medicare Protection Act, to provide critical flexibility for the hardship exceptions process for Stage 2 of the Meaningful Use program. This much-needed bipartisan legislation allows for a blanket hardship exemption for the 2015 reporting period for all providers who apply by March 15, 2016.

The ACOFP strongly supported these efforts through advocacy on the Hill, and this legislation represents an important legislative victory for osteopathic family physicians.

Under the Meaningful Use program requirements issued by the Centers for Medicare and Medicaid Services (CMS), physicians must report for a 90-day period during 2015 in order to avoid future penalties in 2017. However, CMS did not release the final rule with modifications to Stage 2 until October 6, 2015 – less than 90 days before the end of the year. CMS’ own delays left physicians without guidance on how to attest to Stage 2 until it was too late to begin a 90-day reporting period.

While physicians had the option to apply for a hardship exception to avoid the 2017 penalties, CMS would have been required to process these applications on a case-by-case basis. S. 2425 provides a blanket hardship exception for providers who apply by March 15, 2016. This will provide certainty and help alleviate the administrative burden on osteopathic family physicians by eliminating the need to wait for CMS to process each individual application and make a determination.

Physicians will also still be able to apply for a hardship exception before July 1, 2016, but such applications will be processed on a case-by-case basis.

S. 2425 now awaits the President’s signature to become law. ACOFP will provide members with more details on how to apply for a hardship exception as information is made available by CMS.

Legislative Update by Betsy D. Mitchell, MPA

IL-ACOFP Legislative Consultant / December 2015

Medical Practice Act

As one of their legislative actions, on Wednesday, December 2, the Illinois House voted to concur with the Senate to extend the Medical Practice Act until December 31, 2016–only another year again. The Governor is expected to sign this into law before end of the year.

Another Lay Midwifery Bill

Rep. Robyn Gabel (D, Evanston) has just been introduced House Bill 4341 to licensure Certified Professional Midwives, not to be confused with highly trained and educated nurse midwives. This bill has strong bi-partisan support. The Lay Midwives are busy contacting their legislators to urge them to support their bill.

House Bill 4341 requires little to no formal medical or nursing training for CPMs. While the legislation seems to require that candidates obtain training from what is referred to as a pathway accredited by the Midwifery Education and Accreditation Council, there is no single or uniform midwifery curriculum.

House Bill 4341 contains few restrictions on what services are provided by certified professional midwives. The legislation would allow certified professional midwives, who are not trained health care professionals, to perform histories and physicals, provide prenatal care, dispense drugs, treat hemorrhages and other emergencies, and treat the infant and woman postpartum. All of these responsibilities are medical in nature and should only be performed by the professionals who are adequately trained to do so.

A meeting with the Lay midwives has been set for Tuesday, January 26 at location to be determined in Chicago. If you have interest in attending this Q & A session, please let me know. Also please contact your legislators NOW and urge them to oppose this legislation.

Physician Assisted Suicide

A national movement is underway to encourage more states to enact Physician Assisted Suicide legislation. Illinois Catholic Charities is gearing up to oppose this legislation and has asked for us to join their coalition. To date, we have not seen any proposed legislation but it is expected soon. Please let me know your thoughts about this issue. I need to hear from you @ betsy@cook-witter.com

Hep-C Mandate

After losing the battle in the House and Senate, we were finally on the winning side as Governor Rauner and JCAR both opposed this mandate. Governor Rauner vetoed the bill. The supporters are expected to re-introduce the a similar bill in 2016. This legislation would have mandated physicians recommend Hep-C screening to all persons born between 1949 and 1969.

Budget

The Illinois 2016 Fiscal Year budget impasse will continue into 2016. The FY16 budget was to have been implemented on July 1, 2015. We continue to watch many programs shutdown and medical providers not be paid for their services. Many believe that a final budget could be approved in February.

Another busy legislative session is underway in Springfield. To date over 6000 bills have been introduced. Many bills from past sessions have been re-introduced with new bill numbers but the same content as before; among them include: the Home Birth Safety Act (certifying lay midwives), APN independent Practice, mandatory Hep C Screening, and EKGs for all student athletes. Illinois ACOFP and IOMS remain “opposed” to these bills.
Other hot topics in the legislature include:
• Opioids: There are over 20 bills introduced dealing with opioids this year. In the wake of a large increase in heroin-related overdose deaths, Illinois House lawmakers convened a Task Force on the Heroin Crisis, which has been holding hearings all across Illinois for the past year. On Feb. 23rd, the Illinois State Medical Society presented testimony to the Task Force and submitted a 30-page report which includes ideas for strengthening the state’s existing Prescription Monitoring Program. https://www.isms.org/opioidplan/ . IOMS and IAFP Legislative Committees reviewed ISMS’ preliminary plan and offered comments.

Leader Rep. Lou Lang (D/Skokie), the primary sponsor of HB 1 (creates the Heroin Crisis Act) wants mandatory CME a more extensive Prescription Monitoring Program ran by the state. ISMS provided Rep. Lang with a copy of the ISMS recommendations, but he was not very receptive to anything he viewed as less restrictive. While Lang acknowledged that everyone will probably oppose his initial language ISMS has drafted an amendment they plan to offer to Leader Lang . We anticipate this issue remain in flux throughout session.
• Immunizations: Providers are working on passing rules to strengthen the religious exemption process in Illinois. Despite the recommendations from both the ICAAP Immunization Advisory Committee (IAC) and the head of IDPH, the Governor’s office has objected to the inclusion of yearly physician visit as a requirement for religious exemption and has stripped this from the recommendation replacing it with a form that merely states the pro/cons of vaccinations. Alternately, the IAC approach is based on the success in other states of requiring education before exemptions were granted. A coalition is moving forward with a two pronged approach:
1. Drafting a letter to the governor encourage his support of the IAC recommendations
2. Submitting an amendment to be filed by Rep. Robyn Gabel (D, Evanston)
In addition, there are at least three resolutions and two senate bills addressing tightening of religious exemptions: SB1410, SB1776 and HR144, HR184 and HJR26
Fiscal Year 2016 Budget Brief: On February 18, newly sworn-in Governor Rauner unveiled his budget to the General Assembly. The proposed budget calls for no tax increases or new taxes and proposes more than $6 billion in cuts in state spending on universities, health care, local governments and other areas, including reductions in pension benefits for state workers. Governor Rauner’s $31.5 billion spending plan is now before members of the Illinois General Assembly to debate, especially among Democrats, who hold veto-proof majorities in both chambers of the legislature.
Here are some proposed reductions that impact healthcare and human services:
• The Illinois Department of Healthcare and Family Services reports they are the largest insurer in Illinois with 3.18 million individuals covered by Medicaid. As such, they will continue to move up to 60% of their covered population to managed care and reinstate Medicaid eligibility redetermination.
o Another goal will be evaluating the results of different care coordination models.
o Their overall budget was reduced by $1.47 billion (roughly 10%)
• The Illinois Department of Public Health receives only 19% of their budget from the state’s general revenue fund which was reduced by 16% or $21.8 million. Director Shah indicated they will delay hiring and filling vacancies to accommodate some of these cuts.
o A 10% cut will be implemented to numerous grant programs while local health protection grants will be maintained.
o The Tobacco Settlement Recovery Fund will be reduced by $3.1 million with specific cuts to the Tobacco Quitline and Tobacco Free Communities.
• The Illinois Department of Human Services budget reduction totals $423 million, including a 50% cut ($18.5 million) to mental health care coordination.
In addition, the Governor’s budget would re-impose the 2012 state law known as the Save Medicaid Access and Resources Together, or SMART, Act, which cut most adult dental services, podiatry services and a four drug limit for children; all of which were later reinstated at an estimated $320 million.
Work is underway as the leaders in the House and Senate on both sides of the aisle attempt to reconcile their priorities and compromise on a state budget that needs to pass in both chambers by May 31st – stay tuned throughout session! There is much talk that this session will go into an overtime session.
Here is the link to the Office of Management and Budget:
http://www2.illinois.gov/gov/budget/Pages/default.aspx You should be able to select the proposed budget items you wish to view.

U.S. Senate

U.S. Senator Richard Durbin (D) won easily over Illinois State Senator Jim Oberweis, but with Republicans taking the majority, he will no longer be the Senate Majority Whip.

U.S. House of Representatives

The Illinois Congressional Delegation gained two Republican seats with Robert Dold (R) defeating Democratic incumbent Brad Schneider (D) in the 10th Congressional District. In the 12th Congressional District (Southern Illinois), Mike Bost (R) defeated incumbent Bill Enyart (D). Formerly, Bost was a State Representative in the Illinois House. In January, the composition of the Illinois delegation will be comprised of 10 Democrats and eight Republicans.

Governor and Constitutional Officers

Republican Bruce Rauner won the Illinois Gubernatorial race by defeating Governor Pat Quinn. Rauner has set up his transition team and is expected to announce new agency directors soon.

Incumbents Attorney General Lisa Madigan (D), Secretary of State Jesse White (D) and Comptroller Judy Baar Topinka (R) all won re-election. After 10 days, the race for State Treasurer was finally decided in favor of Senator Mike Frerichs over Rep. Tom Cross. There is no word yet on who will replace Frerichs (D, Champaign) as Senator.

Illinois State Senate:

In the Senate, 19 of the 59 seats were up for election and only 7 of the 19 seats were contested in the General Election. The Republicans gained one seat in the Illinois Senate with the defeat of Senator Mike Jacobs (D-36, East Moline) by Neil Anderson a firefighter and paramedic in the Moline Fire Department. Anderson will join Senator Chris Nybo (R-24, Elmhurst) who was appointed to replace Senator Kirk Dillard (R) as the two newly elected faces in the Senate. This means the Senate Democratic caucus will be reduced from 40 to 39 seats, however they will still have a veto proof majority.

Illinois State House:

All 118 House seats were up for election and 70 seats had no opposition (42 Democratic and 28 Republican). Out of the 48 contested races,no Democratic incumbents lost their seat. There will be 20 “new faces” elected to serve in the House in the 99th General Assembly.

Anyone wishing to see a list of the winners, may contact Betsy Mitchell: Betsy@cook-witter.com or 217-493-2474.

Veto Session

Good News. The Illinois Medical Practice Act was approved by the Illinois House of Representatives during the first week of Veto Session. It is expected to be approved by the Illinois Senate during the second week of Veto Session (December 2, 3, 4, 2014). If approved by the Governor after it passes, the Act will only be extended for another year.

Looking Ahead: 2015 Spring Session

The Ninety-ninth General Assembly will be sworn into office on January 14, 2015. This will mark the first year of a two year General Assembly session.

Several scope of practice issues are anticipated. The Advanced Practice Nurses Act sunsets on December 31, 2015 so it will be on the agenda next year. All indications are that they will seek independent practice. The PTs are expected to try again as well.

In addition, we expect to see legislation that would further involve physicians in the issue of gun control and who can carry guns based upon their mental health and capabilities.

Dear Colleagues,
I hope you mark your calendars and plan to join us at the Westin Lombard Yorktown Center for the Illinois Osteopathic Medical Society Annual Meeting and Winter Scientific Seminar on December 4–7, 2014. As the Program Chair, I am excited that the conference will offer something for everyone. The program will provide a wide array of topics presented by knowledgeable speakers. In fact, the conference title, “Bringing Our Specialites Home”, offers a quality CME program close to home for practicing physicians, especially those in Emergency Medicine, Internal Medicine, Family Medicine, Pediatrics, and Obstetrics/Gynecology. You can earn up to 25 CME credits for the entire conference. And if you can’t join us for the entire weekend, you can register and earn credits for individual days attended.

At this writing, only two weeks remain of the Spring Legislative Session in Springfield. The main issue in Illinois is over extending or making the temporary income tax increase permanent. Two years ago, the income tax was increased as a temporary tax. It is set to expire at the end of this year unless legislative action is taken.

For physicians, the session began with the introduction several scope of practice bills (i.e. naturtopathic licensure, dentists to administer vaccinations, prescribing psychologists). As the session comes to a close, the one remaining controversy is over allowing psychologists to prescribe (More information below—See S.B. 2187).

Below highlights several bills that ACOFP-IL/IOMS have taken action on this session:

Psychologists Prescribing: SB 2187 passed the Senate last session in 2013. Since the beginning of the 2014 session, psychologists have been lobbying House members to keep this bill alive. Last week SB 2187 passed out of the House Committee. The bill, opposition, and fact sheets all remain the same. However, this year, the IL Psychiatric Society is taking a greater lead by hiring a public relations firm which created a website, http://coalitionforpatientsafety.com/home and is coordinating efforts for the opposition. We remain very opposed to this legislation.

Funding Poison Control Center (IPC): SB 2674 Harmon/ HB 4230 Lilly. ACOFP-IL and IOMS strongly support this legislation which would reallocate two cents of an existing cell phone surcharge to fund the IPC. Without long-term sustainable funding, the IPC is facing an impending closure date of June 30, 2014. SB2674 is moving. It has passed the Senate and is scheduled for action in the House.

Dentists to provide flu vaccinations: After much discussion, the dentists agreed to all of our concerns, so our opposition to Senate Bill 3409 was removed. The bill will allow dentists enrolled in a medical network or enrolled as a Medicare or Medicaid provider to administer flu vaccinations to patients enrolled in the same medical network or enrolled in Medicare or Medicaid upon completion of appropriate training. Further provides that vaccinations shall be limited to patients 18 years of age and older pursuant to a valid prescription or standing order by a physician and requires notification to the patient’s physician and appropriate reporting and record retention. The bill passed in the Senate and is expected to pass in the House soon.

Community Health Workers: HB 5412 is an initiative of the Governor’s Healthcare Reform Implementation Council and the IL Dept. of Public Health, along with the IL Workforce Investment Board (IWIB) – The abbreviated synopsis of the bill reads as follows: Provides that the core competencies of a community health worker include skills and areas of knowledge that are essential to bringing about expanded health and wellness in diverse communities and to reduce health disparities. Specifies that nothing in the provision concerning the integrated team-based health care, community health workers, and the creation of the Illinois Community Health Worker Advisory Board shall permit a non-certified community health worker to engage in or perform any act or service for which a license issued by a professional licensing board is required.

Flu vaccine required at IDPH facilities– SB 1610 was re-referred to the Senate Committee on Assignments. The abbreviated synopsis reads as follows: Provides that the Department shall require any facility licensed by the Department to implement an influenza vaccination program that requires onsite health care workers affiliated with the facility and persons with privileges on the medical staff to either annually receive an influenza vaccination or, as an alternative to the annual influenza vaccination, wear a facility-provided surgical or procedural mask or other mask that covers the mouth and nose area of the face while this person is performing his or her duties in any patient care area of the facility during the influenza season.

Family Practice Residency Act HB 3946 HA#1 (Ford) – the Family Practice Residency Act is not being resurrected to read as it did when IAFP overrode the Governor’s veto and had it funded in 2005. Instead, they’re using it (the written statute on the books) to codify the use of tobacco settlement $$ to supplement loan repayment. IDPH’s intent, once the amended bill passes, would be for all eligible providers (under the federal definition) to have access to this loan repayment (through tobacco $$) if they were to work in a HPSA (Health Professional Shortage Area). The amended bill has been re-referred to rules.

Uniformed Preauthorization Form HB 3638 Fine/SB 2585 Kotowski – The House bill passed and is now in the Senate. The bill amends the Illinois Insurance Code to provide after January 1, 2015, a health insurer who provides prescription drug benefits must, within 72 hours after receipt of a prior authorization form from a prescribing provider or pharmacist, either approve or deny the prior authorization; and in the case of an expedited coverage determination, the health insurer must either approve or deny the prior authorization within 24 hours after receipt of the prior authorization form. In the case of a denial, requires the health insurer to provide the prescriber with the reason for the denial, an alternative covered medication, if applicable, and information regarding the procedure for submitting an appeal to the denial. The bill also requires health insurers to provide confirmation of receipt of a prior authorization form within one hour after receipt of the prior authorization form. Insurers oppose the bill.

Mandated CME SB 3421-This bill passed the Senate and awaits assignment in House rules but indications are that Rep. Feigenholtz will pick it up as sponsor. Initially, providers were opposed but the amended bill eliminates the requirement that all persons licensed by DFPR who are also mandated reporters must complete the mandated reporter training offered by DCFS. Instead, it would require that IDFPR accept continuing education credit for mandated reporter training offered by the Department of Children and Family Services and completed by any person who holds a professional license issued by the Department and who is also a mandated reporter under the Abused and Neglected Child Reporting Act.

Mandated Hep C Screening SB 2670 – The chairman of Public Health in the Senate, John Mulroe (D-10 Chicago), introduced SB 2670, an initiative of AbbVie, which creates the Hepatitis C Screening Act. The bill synopsis reads as follows: Provides that every individual born between the years of 1945 and 1965 who receives health services from a hospital as an inpatient or in the emergency department of a hospital or who receives primary care services in an outpatient department of a hospital or who receives health services from a health care practitioner providing primary care shall be offered a hepatitis C-related test, unless the health care practitioner providing the services reasonably believes that certain conditions are present. Effective January 1, 2015. After considerable debate in Committee, Senator Mulroe is holding the bill at this time.

Updates on Medicaid Reform and ACA enrollment — This information was published in Illinois Health Connect’s 2nd Quarter News which will be distributed April – June to participating providers.

Care Coordination, aligned with the Illinois Medicaid reform law (Public Acts 096-1501 and 97-689) and the federal Affordable Care Act (ACA, Public Law 111-148), continues to be the centerpiece of the Illinois Department of Healthcare and Family Services Medicaid reform. As Illinois expands its Care Coordination Program, beginning in July 2014, Illinois Health Connect members in the 5 managed care regions (see Care Coordination Expansion map link below) will join a managed care entity. This means that most children, families and newly eligible ACA adults will receive care coordination services in the 5 managed care regions primarily from one of three types of managed care entities. These three types of entities are described below. Counties not included in the 5 managed care regions will continue to include Illinois Health Connect as a plan choice for most individuals enrolled in the HFS Medical program.

Care Coordination Entities (CCE) – provider-organized networks providing care coordination, for risk- and performance-based fees, but with medical and other services paid on a fee-for-service basis (this includes Children with Complex Medical Needs); and

Both CCEs and ACEs have a direct link to the Illinois Health Connect program:
• PCPs who participate in a CCE or an ACE are required to be an active IHC PCP. If you are not enrolled as a PCP in IHC, contact us today.
• Enrollees will need to select both a plan (MCO, CCE or ACE) and PCP for care coordination.
• IHC will process all PCP changes within a members assigned CCE or ACE.
• CCEs and ACEs will collaborate with IHC to manage their panels and assure access to both the medical home and the continuum of services within the CCEs and ACEs.

Finally, the IL Dept. of Healthcare and Family Services Director Julie Hamos reported on the Accountable Care Entities and enrollment numbers below:

4 ACES that will start later on
1. Chicago South Side – St. Bernard and Loretto hospital
2. NorthShore University Health System
3. Population Health of Illinois: Alexian Brothers Health System
4. Trinity Community Ace: Rock Island

Enrollment packets will be mailed from May throughout the fall based on geographical regions for patients to move from Illinois Health Connect into Managed Care Entities in mandatory managed care regions. This HFS Care Coordination Expansion Map http://www.illinoishealthconnect.com/clients/CareCoordinationExpansion.aspx shows the regions and related programs, and this two-page summary http://www2.illinois.gov/hfs/SiteCollectionDocuments/CareCoorPlan.pdf outlines the rollout process and timeline.

Latest numbers of newly enrolled ACA patients is 330,000
36,000 express (childless adults in the 19-64 age group currently in the SNAP program)
121,000 Applications for Benefits Eligibility – ABE (many are still pending)
94,000 County Care (some are pending)
82,000 from Federally Facilitated Marketplace www.healthcare.gov (FFM) initially 125,000 applications sent to Illinois State Marketplace (many pending).

IL Workforce Investment Board Health Care Task Force The Governor’s Health Care Reform Implementation Council and the IL Dept. of Public Health have partnered with IWIB to develop a report with recommendations stemming from the collective work of the five working groups listed below:
1. Eﬀects of Change in Health Care Delivery on Occupational Demand
2. Scope of Practice Issues
3. Front-line paraprofessionals
4. Inter-professional education and practice
5. Regional Strategies to Address Workforce Shortages

Redistricting Amendment There is a campaign to place an amendment on the ballot for the November General election to establish an independent commission the independent Commission which would draw district boundaries for redistricting. Here is the link: http://independentmaps.org/amendment

The Illinois General Assembly ended their session on time — Friday, May 31, 2013. This year their main focus was on the budget, hydraulic fracturing (better known as fracking), pension reform, and the concealed carry of weapons. By the end of session, the legislature had negotiated the $35.4 Billion general revenue budget, passed a concealed carry bill, and Illinois will now regulate fracking. No final action was taken on pension reform so the Governor is calling the legislature back to Springfield to take action on pension reform. The scheduled date for the Special Session will be on Wednesday, June 19, 2013. Leaders are meeting prior to returning in an attempt to reach an agreement.

Clearly, many other issues were debated during this session between January to May. Below please find the major issues of interest to physicians. Please contact me if you have questions or comments about this legislation. In addition, please use this outline as talking points with your legislators over the summer